Infection as a Competing Risk in CLL Registry Data

Danielle M. Brander, MD, of Duke University School of Medicine, opens the discussion with Marc J. Braunstein, MD, PhD, of NYU Grossman Long Island School of Medicine, on infection as a competing risk in chronic lymphocytic leukemia (CLL). Dr Brander cites a nationwide Swedish registry of more than 7000 patients in which nearly half developed a serious infection, and infection was an underlying or contributing cause of death in almost a third, mostly bacterial. A 14-year Australian population analysis of 6000 patients found the proportion with infection nearly doubled over follow-up, with serious infection strongly associated with death. Dr Braunstein says the data are true to his practice: infection remains among the most common causes of mortality even as chemotherapy use declines, and anti-CD20 antibodies carry prolonged immunosuppression. He expects first-year infection rates in US practice to be similar, though fixed-duration therapy may lower rates over time.